Bridging Policy and Practice: Top-level Managers’ Perspectives on Integrated Municipal Care for Older Adults

Background: Delivering safe and integrated care for older adults requires strong horizontal collaboration among professionals and care providers across the care pathway. Equally essential is vertical coordination - ensuring that top-level management aligns policy demands with available resources to effectively support frontline services. This study rethinks and explores municipal top-level managers’ views on safe, integrated home care for older adults with complex needs in Sweden.

 

Approach: This study is part of a larger exploratory project using an embedded case study design. The case focuses on home care for individuals with complex needs and the multilayered coordination of care within one Swedish region and its 12 municipalities. The exploratory approach seeks to deepen understanding from the participants’ perspectives and engages a stakeholder group including managers, professionals, and patient representatives with lived experience. Regular meetings between the researchers and stakeholders supported planning and reflection on findings.

 

The case study is embedded, involving multiple levels of analysis. To explore the service system holistically, it includes subunits such as older adults, family members, professionals, managers at various levels, and service providers. The present study includes municipal top-level managers from 11 municipalities. Their perspectives were gathered through individual interviews and analyzed using thematic analysis [1].

 

Results: The overarching approach to fostering safe and integrated care among top-level managers was characterized by leadership through trust, empowerment, and dynamic collaboration both within and between organizations. The managers emphasized the importance of creating conditions that enable seamless care for older adults living at home, primarily by minimizing cross-organizational barriers. In navigating the broader landscape of preconditions and challenges, they drew upon their mandated roles, which provided them with a sense of control over their work.

To ensure safe and integrated care for older adults, it was essential to empower middle managers and nursing staff to thrive in their respective roles. By practicing distributed leadership grounded in trust, top-level managers aimed to align individuals across the organization toward a shared goal. However, despite their senior positions within their respective organizations, these managers operated within a larger system. This required them to cultivate and leverage effective partnerships - both internal and inter-organizational - to meet the growing demands of caring for older adults with complex needs.

 

Implications: Leading complex and evolving care systems - such as integrated care for older adults living at home - requires both horizontal and vertical collaboration at all levels of management. While initiatives led by top-level managers may contribute to simultaneously improved patient experiences and system-level benefits, these outcomes are of different orders and do not necessarily align.

 

This highlights the need to rethink governance strategies that balance policy demands with the goals of patient-centered care. The findings offer insights into how distributed leadership and trust-based collaboration can support integrated care, while also highlighting the tensions that may arise between individual and system-level outcomes.

1.Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.